Open Access Case Report DOI: 10.7759/cureus.3861 The Association of Iliac and Sacral Insufficiency Fractures and Implications for Treatment: The Role of Bone Scans in Three Different Cases Sandeep Kola 1 , Michelle Granville 2 , Robert E. Jacobson 2 1. Physical Medicine and Rehabilitation, Larkin Community Hospital, Miami, USA 2. Neurological Surgery, University of Miami Hospital, Miami, USA Corresponding author: Michelle Granville,
[email protected] Abstract Iliac wing fractures are under-diagnosed fractures often associated with sacral insufficiency fractures in osteoporotic patients. They are rarely seen alone. Insufficiency fractures of the iliac bone can often be missed on computerized tomography (CT) and magnetic resonance imaging (MRI) yet identified on radioisotope bone scans. Symptomatic iliac fractures present with more lateralized pain in the hip and groin compared to patients with only sacral insufficiency fractures. Since the acetabulum is the key weight- bearing articulation between the sacrum and pelvis and the femoral head and leg, worsening of iliac stress fractures can have major effects on weight bearing and should be a consideration in patients with persistent pain in this area. The anatomy of the ilium and relationship to other pelvic insufficiency fractures is reviewed as well as treatment options. Typical cases are presented where the iliac fractures were found on bone scan either in addition to the more common sacral fracture or due to the persistence of symptoms of hip and thigh pain. Categories: Physical Medicine & Rehabilitation, Radiology, Neurosurgery Keywords: insufficency fractures, ilium, sacral fractures, sacroplasty, acetabulum rim fractures, osteoporosis Introduction The iliac bone composes part of the pelvic ring and can be affected by both traumatic and osteoporotic sacral and pelvic fractures [1-2].